Objectives: To assess critically the safety and effectiveness of intranasal (IN) ketorolac in treating acute pain in both children and adults. Methods: After a comprehensive search of four databases, 1,233 pertinent papers were found. Following the Rayyan QCRI duplicate removal and relevance screening, the search produced 593 publications, 101 full-text articles of which were examined and five of which satisfied the requirements for evidence synthesis. Results: Out of the 1,417 patients in the 5 trials we included, 566 (39.9%) were men. This review provides comparable pain relief results of IN ketorolac to opioids while potentially reducing opioid use. Its administration was linked to fewer unplanned medical visits, demonstrating effective pain control. In pediatric migraine, it showed similar efficacy to intravenous (IV) ketorolac, offering a non-invasive alternative. For renal colic, it provided comparable relief to IV ketorolac and fentanyl, supporting its use in emergency care. In postoperative patients, it significantly reduced opioid consumption while ensuring high analgesic effectiveness and patient tolerance. Conclusion: The effectiveness, tolerability, and opioid-sparing nature of IN ketorolac as a treatment for acute pain in both adult and pediatric patients are confirmed by this review. It provides analgesia equivalent to opioids and IV NSAIDs, making it a valuable non-invasive alternative, particularly in pediatric, emergency, and postoperative settings. However, while current evidence is promising, to determine its long-term efficacy, safety, and ideal dosage, further extensive research is required. Given the growing concerns about opioid dependence, IN ketorolac represents a promising addition to multimodal pain management, contributing to safer and more effective pain control strategies.

Keywords: Analgesia, Ketorolac, Intranasal, Acute pain, Management, Systematic review.